Inspection visit
Inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** R10 is a
[AGE] year-old male. R10 's diagnoses are lung disease, schizoaffective disorder, high cholesterol, heart
disease, thyroid disorder, reflux, high blood pressure, depression, anxiety, auditory hallucinations, psychotic
disorder with delusions due to known physiological condition. R10's MDS (Minimum Data Set) dated
09/29/2023, notes R10 is alert. R10's care plan notes R10 displays behavioral symptoms.
R11 is a [AGE] year-old male. R11's diagnoses are heart disease, major depressive disorder, recurrent
severe without psychotic features, psychosis not due to a substance or known physiological condition,
anxiety disorder, antisocial personality disorder, high blood pressure, schizoaffective disorder, bipolar type,
violent behavior, personal history of traumatic brain injury, and cognitive communication deficit. R11 MDS
(Minimum Data Set) dated 09/25/2023, notes R11 is alert. There are no behaviors listed on R11's care
plan.
Progress note dated 09/15/2023, notes R11 was hit by peer in the face, nose, and back of neck while
waiting to go for smoke break in the hallway. No visible injury, bruising, or redness present currently. R11
was placed in a different room, pending peers transfer to the hospital.
On 1/02/2024, at 1:05 PM, R11 stated, I was sitting here in line, and R10 hit me in the back of the head. I
was trying to talk to R10, and he hit me. I like to joke with people and have fun. This should be on camera. I
do not remember who the staff was or the residents. Residents were lined up behind me. I believe staff
intervened. I forgot about it. All I remember is I could have killed him, but I do not know how to do it.
On 1/02/2024, at 12:54 PM, V12 (Psychiatric Rehabilitation Services Coordinator) stated, I did not witness
this incident. R10 had aggression, was impulsive and sometimes he may have been slightly provoked. R10
was sent to the hospital due to behaviors. It may have been due to this incident. He has been to several
floors. He was physically aggressive. He got moved to the third floor, which was the floor R11 was on.
On 1/03/2024, at 2:15 PM, V1 (Administrator) stated, The camera records and keeps it for five to six days. I
did review camera. It started out being a verbal altercation.
On 1/04/2024, at 10:57 AM, V25 (Registered Nurse) stated, What I saw was a line by the elevator, R10 was
in the line. I am not sure what R11 said to R10. I saw R10 hit R11 on the head or in the back. R10 walks
around. We went there to intervene. I cannot remember the name of the other staff member. When R10 hit
R11, it was in the back of the head. R11 then got into a defensive position. R11 did not hit R10 back. I did
not see any bruising on R11's face. R10 had a lot of behaviors. R10 was very
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 8
Event ID:
145482
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
aggressive. Staff had to watch their backs. R10 liked to walk around and beg things from the residents.
When R10 came to the facility he started on the second floor. R10 was sent out and then moved to the
seventh floor. R10 was sent out again and R10 was moved to the third floor. Yes, I think there were
interventions in place to protect the resident. Staff was monitoring him with these behaviors. We do our best
to monitor the residents. I believe I assessed R11. R11 was complaining of a headache, and he was sent to
the hospital and returned. I told the hospital that R11 was having double vision. This was towards the end of
my shift. When I came back the next day, R11 was back in the facility.
Based on observations, interviews and record review, the facility failed to follow their abuse policy to protect
residents from physical and verbal abuse for three (R1, R5, R11) residents reviewed for abuse in a sample
of six.
Findings include:
On 01/02/2024 at 10:55 AM, surveyor observed R1 walking from the elevator to the dining area. R1 stated
that she had somebody scream at her yesterday. R1 stated that it was V18 (Activity Aide). R1 stated that
she hasn't had a chance to tell anybody yet, but she will today. R1 stated that V17 screams at us routinely.
R1 stated that V19 (Activity Aide) swears and screams at her all the time. R1 stated that she always says,
I'm not putting up with her bullshit.
On 01/02/2023 at 11:20 AM, R13 stated that he has heard V19 (Activity Aide) swear at residents all the
time.
On 01/02/2023 at 11:28 AM, R14 stated that he has heard V19 swears at other residents. R14 stated that
he has heard V17 (Certified Nursing Assistant) yell and swear at residents.
On 01/02/2023 at 10:00 AM, surveyor observed R5 laying in his bed. R5 stated he has seen staff members
be verbally aggressive with residents.
R5's progress note by staff member (09/20/2023) documents: The resident alleged that the staff verbally
abused him. The writer asked what went on and the resident used inappropriate words which he claimed he
used while speaking to the staff. The social service was called, and the administrator was informed. The
staff was called and interviewed and later went home. MD called and notified, and a family member was
called and notified.
R5's facility incident report final intake (09/27/2023) documents in part: The facility's findings indicate that
the staff member was discourteous in her interaction with R5 and making an inappropriate comment about
the resident's appearance.
R5's Progress note by V12 (Social Worker) on 09/21/2023 documents in part: PRSC has met 1:1 with R5
for well-being check after he was involved with verbal altercation with resident and staff. Resident reports
I'm just glad she is not here anymore. I am feeling fine.
R1's MDS Section C Cognitive Patters (11/29/2023) documents in part: R1's BIMS score is 14 which
means R1 is cognitively intact.
R5's MDS Section C Cognitive Patters (12/20/2023) documents in part: R5's BIMS score is 14 which
means R5 is cognitively intact.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 2 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0600
Level of Harm - Minimal harm
or potential for actual harm
R13's MDS Section C Cognitive Patters (12/07/2023) documents in part: R13's BIMS score is 15 which
means R13 is cognitively intact.
R14's MDS Section C Cognitive Patters (01/03/2024) documents in part: R14's BIMS score is 15 which
means R14 is cognitively intact.
Residents Affected - Few
R5 is a [AGE] year-old individual admitted to the facility on [DATE]. R5's current medical diagnosis, as
documented in R5's face sheet includes but not limited to: Unspecified dementia, moderate, with psychotic
disturbance, Hypertensive heart disease without heart failure, Complete traumatic amputation of left lower
leg, level unspecified, sequela, schizoaffective disorder, unspecified. R5's BIMS (Brief Interview for Mental
Status) dated 12/20/2023 document R5 has a BIMS score of 14/15, indicating R5 has intact cognation.
On 01/3/2023 at 12:44pm, R5 said he was experiencing leg pain and pointed to his amputated leg. R5 said
he remembers a staff member make bad comments about his missing limb, but he does not remember who
it was, because it was a while ago.
On 01/03/2024 at 11:25am V1(Administrator) said R5 come to V1 and was really upset and said V15 had
called him names and was making fun of R5's missing (amputated) leg. V1 said she called V15 to question
her and start investigations, and when V15 got to V1's office V1 said V15 told her Don't bother to do you
little binny investigation because I said it and I quit. V1 said that's verbal abuse because V15 humiliated R5
and he (R5) was in tears about it. V1 said she is the abuse coordinator and named types of abuse. V1 said
both V11 and V15 both received abuse training and in-services before hire and when they were working at
the facility.
On 01/03/2024 at 10:15am, V3(Social Services Director) said that R5 had not been happy about the way
the food trays were being passed, and V15 (Former Certified Nursing Assistant-CNA) responded to R5 in
an unprofessional way, making fun of R5's missing limb, and made some derogatory comments about R5.
V3 said R5 told him he was hurt by what V15 said to him, and V15 was reprimanded for her behavior. V3
said staff should not engage with residents because staff are here to help residents with their issues and
staff should not be part of resident issues.
R5's Progress notes dated 09/25/2023 documents R5 reported to social services regarding a verbal
aggression towards him.
Facility Reported Incident Report (FRI) dated 09/27/2023 documents on 09/20/2023, R5 reported to
V1(Administrator) that V15 (Former Certified Nursing Assistant-CNA) hurt his feelings by referring to his leg
appearance. The FRI concluded that V15 was discourteous in her interaction with R5 making an
inappropriate comment about R5's appearance, and V15 admitted that she said it.
Facility Abuse policy titled Abuse Prevention Policy, dated 10/2022, documents:
-Abuse: Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by
accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or
punishment with resulting physical harm, pain, or mental anguish to a resident.
-Verbal Abuse is the use of oral, written, or gestured language that willfully includes disparaging and
derogatory terms to residents or families, or within their hearing distance, regardless of an individuals' age,
ability, to comprehend, or disability.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 3 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0600
Level of Harm - Minimal harm
or potential for actual harm
-Exploitation means taking advantage of a resident for personal gain through the use of manipulation,
intimidation, threats or coercion.
-Misappropriation of Resident Property means deliberate misplacement, exploitation, or wrongful
temporary, or permanent use of a resident's belongings or money without the resident's consent.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 4 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0602
Protect each resident from the wrongful use of the resident's belongings or money.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews and records review, the facility failed to follow their policy for Misappropriation of Resident
Property and Exploitation. This failure resulted in three (R6, R7, R8) residents' being exploited by V11
(Former Certified Nursing Assistant), who took/borrowed their money, and did not buy them stuff or refund
them their money as promised.
Residents Affected - Few
Findings include:
Facility Reported Incident Report (FRI) dated 10/02/2023 documents on 09/26/2023, R6, R7, R8 reported
they gave V11 a total of $226 to purchase snacks for them as follows:
-R6 gave V11 $160, R7 gave V11 $44 and R8 gave V11 $22.
Resident Concerns Forms dated 10/20/2023 documents R6 reported $160 stolen from him, R7 reported
$25 stolen from him, and R8 reported $41 stolen from her.
On 01/03/2024 at 11:25am V1(Administrator) said R6, R7, and R8 all reported at different times that they
had given V11 some money to get them different things but V11 did not buy the items for the said residents
and did not give them their money back. V1 said she asked V11 if he took resident's money, but V11 only
owned up to owing R7 $25 dollars, and that he (V11) would send the money for R7 to V1, but V11 never
did. V1 said she reimbursed all three residents their money as follows: R6- $160, R7- $25, and R8- $41. V1
said Social Services or V1 are the only ones allowed to buy residents items, and the transaction has to be
witnessed and signed off. V1 said staff are not supposed to use resident money, because that's taking
advantage of the residents, and that's a form of abuse. V1 said V11 was terminated right away.
R6 is [AGE] year-old individual admitted to the facility on [DATE]. R6's current medical diagnosis, as
documented on R6's face sheet includes but not limited to: schizoaffective disorder, unspecified, Mild
cognitive impairment of uncertain or unknown etiology, and Congenital renal failure. R6's BIMS (Brief
Interview for Mental Status) dated 12/05/2023 documents R6's BIMS as 15/15, indicating R7 has intact
cognition.
On 01/02/2024 at 11:07am, R6 was in his room siting on his wheelchair and was alert, oriented to person,
place, time and situation. R6 said a while ago (R6 cannot remember the exact dates and times), there was
a staff V11 (Elevator Monitor) who used to ask for money from him and other residents. R6 said V11 would
ask for money every week when R6 gets his stipend money, a $20 dollar, here, a $50 there, up to $160,
and V11 said he would give R6 the money back in double. R6 said this went on for two months, and V11
took the money and never gave the money back to R6. R6 said he felt taken advantage of and used by V11.
V6 further said there were other residents V11 took money from. R6 said V1(Administrator) called the
residents who V11 had taken money from and reimbursed it to all of them.
R7 is a [AGE] year-old individual, admitted to the facility on [DATE]. R7's current medical diagnosis, as
documented on R7's face sheet includes but not limited to: Type 2 diabetes mellitus with unspecified
complications, schizoaffective disorder, unspecified, bipolar disorder, current episode mixed, unspecified,
Major depressive disorder, recurrent, unspecified, Generalized anxiety disorder. R7's BIMS (Brief Interview
for Mental Status) dated 11/26/2023 documents R7's BIMS as 15/15, indicating R7 has intact cognition.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 5 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0602
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 01/02/2023 at 12:27pm, R7 stated R7 does not remember who took his money, and he gets $30 a
month for stipend, and it's not a lot.
R8 is a [AGE] year-old individual admitted to the facility on [DATE]. R8's current medical diagnosis, as
documented on R8's face sheet includes but not limited to: Paranoid schizophrenia, Unspecified psychosis
not due to a substance or known physiological condition, Major depressive disorder, single episode,
unspecified. R8's BIMS (Brief Interview for Mental Status) dated 11/02/2023 documents R8's BIMS as
15/15, indicating R8 has intact cognition.
On 01/04/2023 at 12:45pm, R8 said she forgot who she gave her money to because it was a while ago, but
it was a staff member here at the facility, and V1(Administrator) gave her the money back.
R6, R7, and R8's funds ledger dated 08/01/2023-09/30/2023 documents R6, R7, R8 received funds in their
accounts.
Facility Abuse policy titled Abuse Prevention Policy, dated 10/2022, documents:
-Abuse: Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by
accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or
punishment with resulting physical harm, pain, or mental anguish to a resident.
-Exploitation means taking advantage of a resident for personal gain through the use of manipulation,
intimidation, threats or coercion.
-Misappropriation of Resident Property means deliberate misplacement, exploitation, or wrongful
temporary, or permanent use of a resident's belongings or money without the resident's consent.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 6 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0725
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in
charge on each shift.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to provide sufficient nursing coverage per their
assessed staffing needs to ensure adequate care and support. This failure has the potential to affect all 176
residents that reside in the facility.
Findings include:
On 01/02/2024, V21 (Staffing Coordinator) provided surveyor with the nursing staff schedules dated
09/01/2023 to 12/31/2023.
On 01/03/2024 at 10:49AM, V21 stated this was the entire nursing staff schedule which reflects the actual
names and amount of nursing staff who worked in the facility during that time frame. V21 states whenever
there is a change to the schedule, she updates it as soon as possible to ensure an accurate schedule. V21
states the facility does use agency staff to supplement staffing at the facility. V21 also states the facility no
longer utilizes resident aides/RAs since November 2023. V21 states she staffs according to the budget that
is given to her from V1 (Administrator) and V2 (DON). V21 states this is how she determines how many
nursing staff she is able to staff per day. V21 states V1 and V2 show her the budget sheet and the budget
sheet reflects daily staffing as 28 CNAs daily and 16 nurses daily. V21 states any daily staffing in the facility
that is below 28 CNAs, and 16 nurses is considered below the minimum daily staffing and is considered low
staffing.
Facility nursing staff schedules reviewed for nurses and CNA's from 09/01/2023 to 12/31/2023 for weekend
shifts. The nursing staff schedule documents that out of the 35 weekend days reviewed, there were 7 days
that did not meet the minimum requirements of 28 CNA's and 16 nurses per V21 (Staffing Coordinator). The
following reflects the daily amount of staff who worked in the facility providing direct patient care:
09/03/2023- 14 nurses worked in facility.
09/09/2023- 14 nurses and 25 CNAs worked in the facility.
09/10/2023- 13 nurses worked in the facility.
10/14/2023- 14 nurses and 27 CNAs worked in the facility.
10/15/2023- 12 nurses and 24 CNAs worked in the facility.
12/17/2023- 14 nurses worked in the facility.
12/30/2023- 14 nurses worked in the facility.
Facility census dated 01/02/2024 documents that a total of 176 residents reside in the facility.
Facility assessment dated [DATE] documents in part, Staffing plan 3.2 Based on your resident population
and their needs for care and support, describe your general approach to staffing to ensure that you have
sufficient staff to meet the needs of the residents at any given time. The following is
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 7 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
145482
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sheridan Village Nrsg & Rhb
5838 North Sheridan Road
Chicago, IL 60660
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0725
Level of Harm - Minimal harm
or potential for actual harm
our general staffing for the facility: Position- Licensed nurses providing direct patient care- 8 Registered
Nurses, 8 Licensed Practical Nurses.
Position- Nurse's Aide- 28 CNAs.
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145482
If continuation sheet
Page 8 of 8
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Back to topCitations
3 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F602 - The resident has the right to be free from abuse, neglect, misappropriation of re
Protect each resident from the wrongful use of the resident's belongings or money.
F725 - Nursing Services
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
FAQ · About this visit
Common questions about this visit
What happened during the January 5, 2024 survey of SHERIDAN VILLAGE NRSG & RHB?
This was a inspection survey of SHERIDAN VILLAGE NRSG & RHB on January 5, 2024. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SHERIDAN VILLAGE NRSG & RHB on January 5, 2024?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.